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A`C�" CERTIFICATE OF LIABILITY INSURANCE DATE(MMI02`5")
<br /> THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
<br /> CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
<br /> BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
<br /> REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
<br /> IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed.
<br /> If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on
<br /> this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
<br /> PRODUCER CONTACT
<br /> NAME: Debbie Williams
<br /> HUB International Insurance Services Inc. PH°NE g16-480-4124 FAX Nor 916-993-7224
<br /> PO Box 255387 E-MAIL
<br /> Sacramento CA 95865 ADDRESS: debbie.williams@hubint@rnational.com
<br /> INSURERS AFFORDING COVERAGE NAIC#
<br /> LicenseM 0757776 INSURER A:Nautilus Insurance Company_... 17370
<br /> INSURED INTEDEM-01 INsuRERa:Key Risk Insurance Company 10885
<br /> Interior Demolition Inc 23508 Pine Street INSURER :State Compensation Insurance Fund Of California 35076
<br /> Newhall CA 91321 INSURER D
<br /> INSURER E:
<br /> INSURER F:
<br /> COVERAGES CERTIFICATE NUMBER:954580706 REVISION NUMBER:
<br /> THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
<br /> INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
<br /> CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
<br /> EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br /> INTR TYPE OF INSURANCE ADOL SUBR POLICY NUMBER MMI�DIYYYY POLICY
<br /> M!�Y EXP
<br /> IYYYY LIMITS
<br /> A X COMMERCIAL GENERAL LIABILITY Y Y ECP2035025-14 6/412025 6/4/2026 EACH OCCURRENCE $1,000,000
<br /> DAMAGE T RENTED
<br /> CLAIMS-MADE X OCCUR PREMISES fEa occurrence $100,000
<br /> X $5,000 1)ed1Occur MED EXP(Any one person) $5,000
<br /> PERSONAL&ADV INJURY $1,000,000
<br /> GEN'LAGGREGATE LIMIT APPLESPER: GENERAL AGGREGATE $2,000,000
<br /> POLICY[X]JECT LOC PRODUCTS-COMPIOPAGG $2,000,000
<br /> OTHER: $
<br /> B AUTOMOBILE LIABILITY Y Y 6AP2035024-14 6/4/2025 6/4/2026 COMBINED SINGLE LIMIT $1,000,000
<br /> Ea accident
<br /> X ANY AUTO BODILY INJURY(Per person) $
<br /> OWNED SCHEDULED
<br /> AUTOS ONLY AUTOS BODILY INJURY(Per accident) $
<br /> HIRED NON-OWNED PROPERTY DAMAGE $
<br /> AUTOS ONLY AUTOS ONLY Per aocident
<br /> $
<br /> A UMBRELLA UAB X OCCUR FFX2035026-14 61412D25 6/4/2026 EACH OCCURRENCE $5,000,000
<br /> X EXCESS LIAB CLAIMS-MADE AGGREGATE $5,000,000
<br /> DED X RETENTION$n. $
<br /> C WORKERS COMPENSATION Y 1977624-25 9/27/2025 9/27/2026 X STATUTE ERH
<br /> AND EMPLOYERS'LIABILITY Y 1 N
<br /> ANYPROPRIETORIPARTNERIEXECLITIVE ❑ E.L.EACH ACCIDENT $1,000,000
<br /> OFFICERIMEMBEREXCLUDED? NIA
<br /> (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $1,000,000
<br /> It yes,describe under
<br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000.000
<br /> A Professional Lability ECP2035025-14 614/2025 6/4/2026 Each Claim/Aggregate $1,000,000
<br /> Contractors Pollution Liability Each OcourrencelAgg. $1,000,000
<br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached if more space is required)
<br /> RE: Agreement#A-2022-065-03,On Call Demo.
<br /> Additional Insured: City of Santa Ana,its officers,employees,agents and representatives are named as Additional Insureds with respect to General and Auto
<br /> Liability per the attached endorsements as required by written contract. Insurance is Primary and Nan-Contributory. Waiver of Subrogation applies to Workers'
<br /> Compensation. Excess Liability extends over the Auto Liability,General Liability,Contractors Pollution Liability and Professional Liability. Policies provide for
<br /> 30 Days Notice of Cancellation,except 10 Days for Non-payment of Premium.
<br /> Forms: 10217 0714,BENVCA06 0917,CA0444 1013,CA0449 1116, ECP1220 0121,ECP1246 0121,ECP1248 0121,ECP1259 0121
<br /> CERTIFICATE HOLDER APPROVED w CANCELLATION
<br /> By Tu Tran Nguyen at 4:29 pm,Oct 06,2025 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br /> THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br /> City of Santa Ana ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> Attn: Public Works Agency Dlgitauy signed
<br /> CIPIDesign Engineering TU Tran byraTran
<br /> 20 Civic Center Plaza N AUTHORIZED REPRESENTATIVE
<br /> Dguyen 25.10.06
<br /> Santa Ana CA 92702 M-3(i gUyetlguyen le:ao:6n o�,ep,
<br /> ©1988-2015 ACORD CORPORATION. All rights reserved.
<br /> ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD
<br />
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